病毒性心肌炎致心房静止的电生理学改变及其治疗  

The electrophysiology and treatment of atrial standstill due to virus myocarditis

作　　者：范崇济[1] 张巧芳[1] 李秀英[1] 张宏艳[1] 邢淑华[1] 张莉[1] 

机构地区：[1]天津儿童医院内科,300074

出　　处：《中华儿科杂志》2000年第2期80-82,共3页Chinese Journal of Pediatrics

摘　　要：目的　了解心肌炎致心房静止的电生理学及治疗效果。方法　对 5例年龄为 4～ 11岁伴心房静止的病毒性心肌炎患儿做了心电生理学检查 ,短期应用肾上腺皮质激素及干扰素、安装临时 /永久起搏器进行治疗。结果　十二导联心电图及心房电图均显示心房无电活动且对电刺激无反应。 3例呈交界性逸搏心律 ,其中 2例有Ⅰ°希氏束下阻滞。 2例有交界性心动过速 ,伴有Ⅱ°以上希氏束下阻滞 ,呈 2 :1或 3:1传导。治疗后有 4例出现多种快速室上性及室性心动过速 ,3例出现完全性右束支阻滞或左前分支阻滞 ,均呈动态改变。 1例心电图恢复正常 ,2例分别因遗有Ⅲ°房室阻滞及Ⅱ°Ⅱ型窦房阻滞 ,安装永久起搏器后分别随访 18～ 36个月 ,前者无改变 ,后者出现阵发性房颤。 1例Ⅲ°房室传导阻滞随访 8个月无症状 ,1例自动出院后死亡。结论　心房静止除窦房结及心房外 ,传导系统常广泛受累 ,心动过缓和心动过速可交替出现 ,多难于完全恢复且需安装永久起搏器治疗。Objective To clarify electrophysiologic abnormalities and evaluate the treatment of atrial standstill due to virus myocarditis. Method Five cases of virus myocarditis, aged 5～11 years,were examined by the electrophysiological method. They were treated with temporary pacemakers, steroides and interferon in a short term. Two of them were paced permanently. Result Electrophysiologic study showed atrial standstill and no response to electric stimulation in all cases. Three cases had junctional escape rhythm,including 2 children with Ⅰ°infraHis bundle block. Two cases had junctional tachycardia with ≥Ⅱ°infraHis bundle block manifesting as 2∶1 to 3∶1 conduction. Episodes of various supraventricular tachycardia and ventricular tachycardia occured in 4 cases,and complete right bundle block and left anteior hemiblock in 3 cases. One case completely recovered. Two cases who had complete A V block and Ⅱ°typeⅡsinoatrial block, respectively, were paced permanently and followed for 18～36 months, the former had no change, the latter had paroxysmal atrial fibrillation with a good response to amiodarone. One case with complete A V block was followed for 8 months and showed no symptom. One case who had no improvement was discharged voluntarily and died finally. Conclusion Besides sinus node and atrium, the whole conduction system was involved, therefore the permanent pacing was often needed.

关 键 词：心脏传导阻滞 心肌炎 电生理学 心脏起搏 儿童 

分 类 号：R542.21[医药卫生—心血管疾病]